Healthcare Provider Details

I. General information

NPI: 1912838269
Provider Name (Legal Business Name): MR. JASE HARRISON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42145 30TH ST W
LANCASTER CA
93536-3342
US

IV. Provider business mailing address

2825 HUSTON PL
LANCASTER CA
93536-1803
US

V. Phone/Fax

Practice location:
  • Phone: 661-943-3255
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: